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Related Experiment Videos

Differences between anterior and posterior circulation stroke in TOAST.

R B Libman1, T G Kwiatkowski, M D Hansen

  • 1Department of Neurology, Long Island Jewish Medical Center, Long Island Campus, Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA. libman@lij.edu

Cerebrovascular Diseases (Basel, Switzerland)
|June 1, 2001
PubMed
Summary

Anterior circulation (AC) and posterior circulation (PC) strokes have different symptoms, but outcomes are similar when controlling for prognostic variables. Heparinoid treatment efficacy did not differ between AC and PC strokes.

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Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Anterior circulation (AC) and posterior circulation (PC) strokes are often viewed as distinct entities.
  • Differences in pathogenesis, natural history, and treatment response, including anticoagulation, are traditionally assumed.

Purpose of the Study:

  • To investigate the differences between AC and PC strokes within the Trial of ORG 10172 in Acute Stroke Treatment (TOAST).
  • To compare outcomes and treatment responses in patients with AC versus PC strokes.

Main Methods:

  • Analysis of prospective clinical data from 1,039 AC stroke and 180 PC stroke patients in the TOAST trial.
  • Comparison of demographics, risk factors, stroke subtypes, and outcomes at 3 months using Fisher's exact test, t tests, and analysis of covariance.

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  • Multivariate analysis controlling for gender, prior stroke history, and baseline National Institutes of Health Stroke Scale (NIHSS) score.

    • Main Results:

    • PC stroke patients reported more headache and vomiting. Baseline NIHSS scores were lower (less severe strokes) in PC patients compared to AC patients.
    • Univariate analysis showed more favorable outcomes for PC patients, but multivariate analysis controlling for prognostic variables revealed no significant difference between AC and PC stroke outcomes.
    • No interaction was found between vascular distribution and treatment, indicating heparinoid efficacy was similar for both AC and PC strokes.

    Conclusions:

    • While AC and PC stroke patients differ in some clinical presentations and baseline severity, long-term outcomes are comparable when adjusted for prognostic factors.
    • PC stroke patients did not demonstrate a specific benefit from anticoagulation, and heparinoid efficacy was consistent across both vascular distributions.
    • Treating PC stroke patients as a distinct group for anticoagulant therapy may not be appropriate.